Received Nov 30, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| FLU3 | INFLUENZA (SEASONAL) (FLUCELVAX) | SEQIRUS, INC. | 2 | 407005 | LL |
| HEPA | HEP A (VAQTA) | MERCK & CO. INC. | 1 | Z005852 | IM / LL |
| MMR | MEASLES + MUMPS + RUBELLA (MMR II) | MERCK & CO. INC. | 1 | Y019107 | IM / RL |
| VARCEL | VARICELLA (VARIVAX) | MERCK & CO. INC. | 1 | Z008430 | IM / RL |
This patient experienced a tonic clonic seizure 3 days after receipt of the above vaccines. She had a new onset fever to 102 on the day of the seizure and was noted to have generalized tonic clonic seizures in the field necessitating antiseizure meds - benzodiazapines . Patient is a 12 m.o.-old with history notable for perinatal HIE with acute symptomatic seizures (requiring Phenobarbital, Fosphenytoin, Keppra and Midazolam drip) not on standing ASMs presenting for evaluation of seizure activity, described as shaking involving bilateral upper and lower extremities with rhythmic blinking lasting 2-3 minutes. Of note, she received 12-month vaccines (MMR, Varicella, Hep A) three days prior to presentation. MRI brain showed expected evolution of known prior hypoxic-ischemic injury. Presentation is most likely consistent with seizures provoked by fever in the context of likely epilepsy given known abnormalities on MRI, therefore will discharge on standing keppra with neurology follow-up. Further more, the patient was noted to have a new onset arachnoid cyst on the MRI during this hospitalization that was creating a mass effect on the left hemisphere She was also noted to have RUL pneumonia on cxr the day of admission
Parents reported that the patient had a cold for 5 days prior, but that it was improving and patient was afebrile
This patient had hypoxic ischemic encephalopathy noted at birth. From the medical record: At 12 hours of life left sided seizure activity noted, required intubation for apnea, HUS on 11/10 and 11/ showed slit- like ventricles, but no bleed. EEG c/w seizure activity rx'd phenobarb,phosphenytoin, keppra, midazolam, DOL 23- phenobarb d/c , 11/12 MRI c/w mixed profound and partial prolonged HIE 11/25 MRI- HIE< within the cerebral hemispheres with evidence of encephlaomalacia, cortical laminar necrosis and Walleria degeneration in the brainstrem and corpus callosum. 12/9 abnormal eye movements, EEG- showed spike/ wave abnormalities, but no frank seizure activity S/p r/o sepsis c/ normal wbc and negative LP. Patient went home on NGT feed, which came out upon d/c and parents did not replace, Parents have declined all neurology follow up
Vitamin D, 10 mcg daily
None
Head CT- 11/15/25 abnormal eft hemispheric atrophy with moderate subcortical white matter low-attenuation consistent with hypoxic ischemic encephalopathy/encephalomalacia. Arachnoid cyst within the left middle cranial fossa extending into the sylvian fissure. Brain MRI 11/16/25- abnormal, No acute findings. Chronic changes related to prior hypoxic ischemic injury involving both cerebral hemispheres, left more than right. New arachnoid cyst with associated mass effect on the left temporal lobe and sylvian fissure as described. CXR: 11/15 The endotracheal tube tip projects over the lower thoracic trachea toward right main stem bronchus, malpositioned. Consider retracting several centimeters for proper positioning. 2. Patchy right upper lobe opacity, which could reflect atelectasis, aspiration, or pneumonia in the proper clinical setting. Close attention on follow up study will be helpful for the assessment of interval change / resolution. 11/16/25 repeat cxr Endotracheal tube with tip overlying upper thoracic trachea. 2. Similar right upper lobe atelectasis extensive labs, EEG- abnormal